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Kidney Week

Abstract: TH-OR31

Risk Factors for AKI During Autologous Stem Cell Transplantation in AL Amyloidosis

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Nader, Ralph, Boston University School of Medicine, Boston, Massachusetts, United States
  • Pavlovich, Stephanie S., Boston University School of Medicine, Boston, Massachusetts, United States
  • Angel-Korman, Avital, Boston University School of Medicine, Boston, Massachusetts, United States
  • Pogrebinsky, Alexander, Boston University School of Public Health, Boston, Massachusetts, United States
  • Doros, Gheorghe, Boston University School of Public Health, Boston, Massachusetts, United States
  • Menn-Josephy, Hanni, Boston University School of Medicine, Boston, Massachusetts, United States
  • Stern, Lauren D., Boston University School of Medicine, Boston, Massachusetts, United States
  • Sarosiek, Shayna, Boston University School of Medicine, Boston, Massachusetts, United States
  • Brauneis, Dina, Boston Medical Center, Boston, Massachusetts, United States
  • Sanchorawala, Vaishali, Boston University School of Medicine, Boston, Massachusetts, United States
  • Havasi, Andrea, Boston University School of Medicine, Boston, Massachusetts, United States
Background

Acute kidney injury (AKI) is a common complication after high dose melphalan and autologous stem cell transplantation (HDM/SCT) in AL amyloidosis patients. However, its incidence, outcome and risk factors are not well known.

Methods

This observational study included 173 AL amyloidosis patients who underwent HDM/SCT in the Amyloidosis Center at Boston University School of Medicine. Demographic, laboratory and clinical data were prospectively collected and analyzed retrospectively. AKI was defined as an increase in serum creatinine to ≥ 1.5 times the baseline value and occurring within the first 30 days after HDM/SCT.

Results

The median age was 57 years (range 32-77). Fifty-nine percent of patients were male. Renal and cardiac involvement were present in 65.3% and 19.7% of patients, respectively. Median eGFR was 83 mL/min/1.73m2 (range 9-213) and median proteinuria was 2,503 mg/24h (range 0-19,996). The median time from diagnosis to SCT was 4 months (range 1-100). AKI occurred in 28.3% of patients. The causes of AKI were: ATN (27.9%), pre-renal injury (26.4%), melphalan-induced AKI (12.0%), cardiorenal physiology (5.8%), AIN (2.9%), contrast-induced AKI (1.5%), obstructive nephropathy (1.5%), and no clear etiology (22.0%). AKI was associated with increased overall mortality with a hazard ratio of 4.78 (95% CI, 1.9-11.9, p<0.001). The 10-year overall survival was 87.5% for patients who did not have AKI versus 56.2% who had AKI. Baseline characteristics significantly associated with AKI development were: amyloid renal involvement, renal function, proteinuria, hypoalbuminemia, IVSD, atrial fibrillation, use of midodrine or diuretics. Sepsis in the post-transplant period, IV vancomycin use, and C. difficile infection were significantly associated with AKI. In terms of hematologic factors, anemia severity, and the need for red blood cell transfusion were significantly associated with AKI. Prolonged thrombocytopenia was associated with AKI; however, delayed WBC engraftment was not associated with AKI.

Conclusion

AKI occurs frequently after HDM/SCT in AL amyloidosis patients and is associated with several risk factors and an increased overall mortality. Prophylactic measures addressing some of these risk factors may reduce this risk.